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General NPI Number Information
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NPI Number | 1609989730
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Entity Type | Organization
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Legal Business Name | CHESAPEAKE PRIMARY CARE GROUP PA
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 05/06/2011
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Provider Practice Location Address
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Address Line | 4304 MOUNTAIN RD
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City | PASADENA
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State | MD
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Zip | 21122-4520
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Country | US
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Telephone | 410-360-2400
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Fax | 410-439-3342
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Provider Business Mailing Address
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Address Line | 14650 VIBURNUM DR
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City | DAYTON
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State | MD
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Zip | 21036-1246
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Country | US
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Telephone | 410-360-2400
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Fax | 410-439-3342
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PRADEEP GARG
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Credential | M.D.
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Telephone | 410-360-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D31322
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License Number State | MD
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